UROLOGIC HEALTH PROGRAM STONE

TYPES OF KIDNEY STONES HOW TO REACH US UW Health and its nationally renowned The type of stone is determined by its composition. If you suspect you have kidney stones, visit your stone disease program offer state-of-the- primary care provider or urologist. art therapy and preventive strategies in the •  is the most common type of UW Health 1 S. Park Clinic diagnosis and treatment of kidney stone disease. stone and represents about 70 percent of stone 1 S. Park St., Madison, WI 53715 disease cases. (608) 287-2900 Our urologists recognize that patients suffering from stone disease deserve compassionate, • Calcium and are two other If you've been diagnosed with stones and would high-quality care that provides both practical common types of stones. Patients will commonly like to be seen in the Metabolic Stone Clinic, develop a combination of calcium oxalate, please call (608) 263-4757. and effective treatment. Their treatment and uric acid stones. approach includes both surgical and medical UW Hospital and Clinics •  is a less common type of stone. 600 Highland Ave., Madison, WI 53792 options as well as a nutritional program. (608) 263-4757 • Rare stones include those induced by medications ABOUT STONE DISEASE or caused by genetic disorders. For more information, visit uwhealth.org/urology A kidney stone is a hard, stone-like mass (also called a ) developed from tiny crystals that form in . Stones form from these small crystals, which attach to the inner surfaces of the kidney, grow into larger crystals and eventually become stones.

Stones can form in one or both kidneys and typically

range from less than five millimeters in size to as UW Hospitals and Clinics consistently ranks in large as 10 millimeters or more. The size of the the Top Hospitals in Urology based on the annual stone, determined through imaging studies such US News and World Report surveys. as X-rays, indicates whether an individual can Our Department of Urology offers center-oriented spontaneously pass the kidney stone through the specialty treatments and consultations in urologic urinary tract or if surgical intervention is required. cancers, stone disease, , voiding dysfunction and male sexual health. Kidney stones can be debilitating and painful, and recurrent stone formation may lead to a decreased quality of life, interruptions in work and social commitments, an increased need for medical care or hospitalization and even kidney damage. UW Health urologists are committed to helping patients improve their quality of life through medical treatment and preventive strategies to manage their disease.

UR-42051-15 uwhealth.org/urology

KIDNEY STONE DISEASE Innovative Research. Outstanding Care.

SYMPTOMS • Medication Contributors: Certain medications such NUTRITION AND KIDNEY STONES Sometimes there are no symptoms associated as decongestants, , heart medications, calcium The UW Health Stone Disease Program is committed to with the presence of kidney stones. These may not channel blockers, and steroids may increase providing nutrition therapy for patients and unlike most require surgical intervention if they remain small and risk for developing kidney stones. other centers, has had a clinical nutritionist on staff since asymptomatic. the program’s inception in 1995. Nutrition therapy is highly DIAGNOSIS personalized and implemented based on an individual's

SYMPTOMS MAY INCLUDE: The presence of kidney stones is confirmed with imaging 24-hour urine biochemistry, blood chemistry, stone type Stephen Y. Nakada, MD Sara L. Best, MD • Pain, which can be dull or excruciating, in the flank studies that may be used as part of the diagnostic process, and other medical considerations, such as medications and area and may come in spasms and may radiate to such as CT scans, and X-rays. other . A comprehensive dietary assessment helps other areas determine if there are dietary contributors to the patient’s • Fever TREATMENT stone disease. The following are some common elements of nutrition therapy for kidney stones: • Burning during urination Medical management is an effective means by which to reduce the risk of future stone formation. Medical •  and vomiting • Fluids • Calcium • Lemon juice management incorporates observation, medication therapy, •  • Fruits and •  and nutrition therapy, surgery or a combination of all of them. There may also be blood and in the urine. • Oxalate vegetables carbohydrates Andrew K. Graf, MD Sean P. Hedican, MD Kidney infections and possible long-term kidney damage may result. Treatment for confirmed kidney stones differs depending on: MEDICATIONS Medicine is prescribed based on a patient's specific risk CAUSES • The patient's symptoms • The size and location of the stone factors, using urine and blood biochemistries as well as the • Genetic Heritability: Approximately 40 percent of person's medical history. They may include: people who form kidney stones have a positive family • The patient's medical history, including the existence history for stones. People with this inherited trait of any anatomic abnormalities or diseases • Diuretics •  • - often begin forming stones early in life. •  • Antibiotics lowering drugs Common treatments for stones that are not severe include: Granville L. Lloyd, MD David R. Paolone, MD • Disease-Related Contributors: Some diseases citrate • Cholestyramine • Drinking lots of fluids (100 ounces per day or more) to associated with kidney stones include hypercalcemia, : pass the kidney stone SURGICAL TECHNIQUES hyperthyroidism, Crohns and other bowel diseases, Roy A. Jhagroo, MD insulin resistance, , , or • Medications which may be prescribed to help patients Surgical treatment may include the following: NUTRTION: being bedridden. Though not everyone with these tolerate pain that may be associated with stone passage • Extracorporeal Shock Wave (ESWL): Kristina L. Penniston, PhD, RD diseases will develop kidney stones, they may benefit • Exercise which may be helpful in the passage of a This technique uses sound waves (also called shock from preventive strategies. kidney stone waves) to break a kidney stone into very small pieces that can more easily travel through the urinary tract • Environmental Contributors: Certain environmental Other treatment options may include the following: factors including level of physical activity, work and out of the body. • Percutaneous Nephrostolithotomy or • Nutrition therapy environment, nutrition, body mass, gender, age and •  (URS): URS is the removal of a kidney Nephrolithotomy (PCNL): This approach is an ethnicity may affect one’s risk for kidney stones. • Medications stone through the without making an incision. alternative to a ureteroscopy. With a PCNL procedure, • Anatomical Abnormalities: Certain conditions such • Surgical techniques The URS may be done if the kidney stone is too large the urologist makes a one-centimeter incision in as caliceal diverticulum, ureteropelvic junction (UPJ) for ESWL or has become lodged in the . The URS the back or side of the abdomen. A nephroscope is obstruction and ureteral strictures may contribute is considered for individuals who have previously had passed through the incision to the stone location and to an increased risk of kidney stones. ESWL but whose stones were not completely removed. the stone is removed.